Every day, ketamine is used in emergency rooms around the world to sedate patients for surgery. This drug is generally well-tolerated and isn’t habit-forming, making it an effective option for managing pain in combat situations or during surgical operations.
More recently, researchers have found that ketamine, administered either intravenously or in nasal spray form, can provide fast-acting relief for treatment-resistant depression.
Ketamine is also found in nightclubs throughout North America and Europe, with thousands of individuals taking ketamine for the mind-bending, out-of-body experience it induces. In 1999, the U.S. Drug Enforcement Agency classified it as a Schedule III non-narcotic substance under the Controlled Substances Act, recognizing that it was prone to misuse.
Understanding Ketamine
Ketamine is a dissociative anesthetic that’s been approved by the Food and Drug Administration since 1970 for use in surgery. This drug is an NMDA receptor antagonist, meaning that it affects the receptors that control how the individual experiences pain, manages their mood and experiences the world around them. Over 50 years after its approval from the FDA, this drug is still commonly used in inpatient hospital settings for inducing and maintaining sedation during surgery.
While ketamine was originally used as an anesthetic, health care professionals began to note wider applications for this drug shortly after it was in regular use. For example, first responders have been using it for decades to relieve pain or to calm a person they may have rescued from a suicide attempt, and some doctors use ketamine to treat suicidal thoughts and severe, treatment-resistant depression. The drug has also been used off-label for long-term pain management.
Along with medical uses, ketamine has been used recreationally for the dissociative experience it creates. It can cause visual and sensory distortions, temporary unusual thoughts and a sense of unreality, making it a popular party drug. Giving it nicknames such as Special K, Vitamin K and Super K, partiers inject this drug, snort it, add it to drinks or put it in cigarettes or joints.
Uses and Benefits
Most commonly, ketamine has been used in anesthesia for its ability to induce a state called “dissociative anesthesia,” meaning it causes the patient to go into a trance-like state where they feel detached from their surroundings. It blocks the NMDA receptors in the spinal cord and brain, preventing the body from transmitting pain signals and other sensations. Unlike many other anesthetics, it preserves the body’s reflexes, meaning the individual continues to breathe normally. For that reason, it’s a common choice in combat or emergency situations when it’s important for the individual to maintain vital functions.
In addition to being used as an anesthetic, it’s sometimes used in emergencies when an individual is experiencing an asthma attack. It causes the airways to widen, enabling the individual to take in oxygen. It also stimulates the heart, increasing the heart rate and blood pressure, making it beneficial for patients experiencing medical emergencies linked to heart disease or low blood pressure.
In recent years, clinical research has found ketamine to be effective for major depression that has not responded to other interventions. Unlike other drug therapies for depression, which typically take weeks to reach maximum effectiveness, ketamine often brings positive changes within hours of administration. In some cases, health care providers administer esketamine, which is derived from ketamine but has a different molecular structure that lets it be more potent in smaller doses, and therefore, safer with fewer side effects.
Risks and Side Effects
Because of its potentially serious side effects, as well as its risk of being misused, ketamine should only be administered in a clinical setting under the supervision of an experienced health care provider. Even with correct use, this drug can cause changes in blood pressure, drowsiness, dizziness, memory problems and stomach upset.
When ketamine is used recreationally, its risks and side effects increase substantially. Some of the most common risks include:
- Ulcerative cystitis
- Memory impairments
- Paranoia
- Chest pain
- Nervousness
- Seizures
- Increased blood pressure
- Unconsciousness
Ketamine isn’t habit-forming, and even individuals who use the drug recreationally over a long period of time don’t experience withdrawal symptoms after it leaves their system. However, while individuals aren’t likely to develop a physical dependence on the drug, they may become psychologically dependent on it, especially if they’re using it to self-manage a mental health condition.
Precautions and Considerations
Ketamine is a powerful medication, and it’s imperative that individuals only use it under medical supervision according to doctor’s orders. Some additional precautions and considerations related to ketamine include:
- Age Considerations: While ketamine is typically well-tolerated in those aged 3-60 years old, it can cause serious side effects in younger patients. Those aged 3 and under may experience weakness, difficulty walking, vision disturbances and headaches.
- Drowsiness and Confusion: Ketamine can cause the individual to feel drowsy or confused. If someone receives a dose of ketamine, their doctor may recommend that they not drive, operate heavy machinery or participate in other activities that require focus for 24 hours after being medicated.
- Interactions: Because ketamine interacts with alcohol and certain depressants, such as sleep medicine, patients need to be up-front about their drinking habits and any prescription or over-the-counter sleep medicines they take. These interactions can also increase the dangers related to taking ketamine recreationally, as the drug is often used alongside alcohol or depressants such as marijuana.
- Pregnancy: Because of ethical considerations, ketamine’s safety and effectiveness haven’t been tested on pregnant people. Those who are pregnant should refrain from taking ketamine recreationally and make sure their doctors are aware of the pregnancy before receiving this drug in a clinical setting.
- Post-Surgery Side Effects: Even in a clinical setting, ketamine can cause confusion or cause the individual to experience a distorted sense of reality. Fortunately, this typically resolves on its own within a few hours. If the effects of the medicine are severe or last more than about 24 hours, medical intervention may be necessary.
- Liver Health: Because the liver plays a significant role in metabolizing ketamine, the drug may not be suitable for those living with liver problems. Some issues to watch for, whether the drug is taken under a doctor’s supervision or recreationally, include stomach pain, digestive upset, yellowing of the eyes or skin, dark urine or light-colored stools.
Dosage and Administration
In a surgical setting, the proper dosage of ketamine varies between 1-13 milligrams depending on the patient’s age, weight, liver health, and whether the drug is administered intravenously or intramuscularly. Health care providers administer the medication slowly, over a period of about a minute, to make sure it works properly without putting too much stress on the body.
It’s more difficult to gauge how much ketamine people use in a recreational setting. Because street drugs often contain a cocktail of chemicals (and may not even contain the sought-after substance), it’s virtually impossible for someone to know what they’re really taking and how much of it they’re getting. Because individuals aren’t able to control the dose they receive of ketamine – or any other chemical in the mixture – taking it recreationally is especially risky.
Treatment Duration and Withdrawal
Without further administration, ketamine’s effects typically last for about an hour, though they can continue for as long as a day depending on the dosage and how it was administered. Ketamine isn’t habit-forming and doesn’t bring on withdrawal symptoms, so people typically have no issue with quitting the drug, even if they’ve taken it for an extended period of time.
Conclusion
Ketamine is a strong drug and should only be used under close medical supervision in a clinical setting. While research supports its efficacy for depression, it should only be prescribed in cases of severe and/or treatment-resistant depression. Meanwhile, its safety for surgery is widely documented and has been observed for decades, making it the go-to anesthetic for many health care professionals.
